Method of glenohumeral instability repair

Abstract

Methods for arthroscopic bone graft for anterior inferior glenohumeral instability repair are disclosed. The method includes providing a bone graft not attached to soft tissue. Respective passageways are formed through the bone graft and a patient's glenoid. A first implant is further provided, where the first implant is secured to a first end of a suture. The first implant is positioned on the cortical side of the bone graft and the cancellous surface of the bone graft is urged into contact with the anterior surface of the glenoid. A second implant is provided, including an eyelet extending there through. The second end of the suture is inserted through the eyelet of the second implant. The second implant is further placed in contact with the posterior surface of the glenoid. Subsequently, the second end of the suture is secured to the second implant.

1 . A method of glenohumeral instability repair, comprising:
 forming at least one passageway through a bone graft, the bone graft having a cortical side and a cancellous side, wherein the bone graft is not attached to soft tissue;   forming at least one passageway through a glenoid, from a posterior surface to an anterior surface;   positioning a first implant secured to a first end of a suture on the cortical side of the bone graft;   drawing the suture posteriorly, through the bone graft passageway and the glenoid passageway, wherein after the suture is so drawn, a second end of the suture is positioned on the posterior side of the glenoid, the first implant contacts the cortical side of the bone graft, and the cancellous surface of the bone graft is urged into contact with the anterior surface of the glenoid;   inserting the second end of the suture through an eyelet of a second implant;   positioning the second implant in contact with the posterior glenoid surface; and   securing the second end of the suture to the second implant.   
     
     
         2 . The method of  claim 1 , further comprising forming a posterior portal to allow access to the glenoid. 
     
     
         3 . The method of  claim 1 , wherein the bone graft is an allograft. 
     
     
         4 . The method of  claim 1 , wherein the bone graft is not a coracoid process. 
     
     
         5 . The method of  claim 1 , wherein the bone graft has a length between about 10 mm to about 20 mm. 
     
     
         6 . The method of  claim 1 , wherein the bone graft has a width between about 8 mm to about 10 mm. 
     
     
         7 . The method of  claim 1 , wherein the bone graft has a thickness of about 5 mm to about 11 mm. 
     
     
         8 . The method of  claim 1 , wherein forming at least one passageway through the bone graft comprises drilling at least one passageway through the bone graft with a drill. 
     
     
         9 . The method of  claim 1 , wherein the at least one passageway through the bone graft is two passageways through the bone graft. 
     
     
         10 . The method of  claim 9 , wherein the two passageways through the bone graft are spaced about 10 mm apart. 
     
     
         11 . The method of  claim 1 , wherein the at least one passageway through the bone graft has a diameter of about 3 mm. 
     
     
         12 . The method of  claim 1 , wherein forming at least one passageway through the glenoid comprises drilling at least one passageway through the glenoid with a drill. 
     
     
         13 . The method of  claim 12 , wherein the drill is a 2.8 mm sleeved drill. 
     
     
         14 . The method of  claim 1 , wherein the at least one passageway through the glenoid is two passageways through the glenoid. 
     
     
         15 . The method of  claim 14 , wherein the two passageways through the glenoid are spaced about 10 mm apart. 
     
     
         16 . The method of  claim 1 , wherein a distance between the at least one passageway through the bone graft and another passageway through the bone graft is substantially equal to a distance between the at least one passageway through the glenoid and another passageway through the glenoid. 
     
     
         17 . The method of  claim 1 , wherein the at least one passageway through the glenoid is placed about 4 mm to about 5 mm on center below a cortical edge of the anterior surface of the glenoid. 
     
     
         18 . The method of  claim 12 , wherein drilling at least one passageway through the glenoid with a drill comprises passing the drill through a billet secured to the posterior surface of the glenoid. 
     
     
         19 . The method of  claim 18 , wherein securing the billet to the posterior surface of the glenoid comprises securing the billet with a glenoid guide. 
     
     
         20 . The method of  claim 1 , wherein drawing the suture posteriorly comprises drawing a guide wire to which the suture has been secured posteriorly. 
     
     
         21 . The method of  claim 1 , wherein securing the second end of the suture to the second implant comprises tying a knot in the suture. 
     
     
         22 . The method of  claim 21 , wherein the knot is a Nice Knot. 
     
     
         23 . The method of  claim 1 , wherein the second implant is a round endbutton. 
     
     
         24 . A method of securing a bone graft to a glenoid, the method comprising:
 forming first and second passageways through a bone graft having a cortical side and an opposing cancellous side;   forming first and second passageways through a glenoid of a patient, from a posterior surface to an anterior surface, a distance between the two passages through the glenoid being substantially the same as a distance between the two passages through the bone graft;   positioning a first implant secured to a first end of a first suture on the cortical side of the bone graft by drawing the first suture posteriorly through the first passageway in the bone graft and the first passageway in the glenoid;   positioning a second implant secured to a first end of a second suture on the cortical side of the bone graft by drawing the second suture posteriorly through the second passageway in the bone graft and the second passageway in the glenoid;   attaching a third implant to a second end of the first suture near the posterior surface of the glenoid;   attaching a fourth implant to a second end of the second suture near the posterior surface of the glenoid; and   tensioning the first and second sutures such that the third and fourth implants are urged into contact with the posterior surface of the glenoid and the bone graft is secured to the anterior surface of the glenoid.   
     
     
         25 . The method of  claim 24 , wherein the first and second implants are the same. 
     
     
         26 . The method of  claim 24 , wherein the third and fourth implants are the same. 
     
     
         27 . The method of  claim 24 , wherein the bone block is one of an autograft, an allograft, or a synthetic. 
     
     
         28 . The method of  claim 24 , wherein the two passageways through the glenoid are spaced about 10 mm apart. 
     
     
         29 . The method of  claim 24 , further comprising positioning a hook end of an arm of a drill guide on the anterior surface of the glenoid, the drill guide comprising at least one bullet for passage of a drill. 
     
     
         30 . The method of  claim 24 , wherein the two passageways in the bone graft are formed about 5 mm from an edge of the bone graft.